Intraoperative svt

[anbuitachi]

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Seen a few of these before intraoperative. I thought first line is adenosine unless unstable then sync shock. However I've never seen adenosine used in the OR for Svt. They usually use other drugs first like esmolol or dilt which I thought were 2nd line. What are your thoughts? Do you go for the adenosine first if svt doesn't break on its own after a few minutes?

 

[deleted162650]

First I mash on their eyeballs and dump ice on their head. When that doesn’t work I go straight to vigorous bilateral carotid massage.

 

[vector2]

In the OR I would probably only be reaching for adenosine first if the patient had a history of SVT or some primary structural heart disease. Most of the SVT I see occurs in sicker patients who are having some sort of oxygen demand/supply imbalance. In someone who is semi-stable (sbp 80-90), rather than risk having a nodal pause that degenerates into something worse I'd rather push esmolol/neo first and make sure I've corrected hypoxia, anemia, relative hypotension, electrolytes and volume status before reaching for the big guns. Obviously though, make sure the adenosine and pads are still handy before trying to fix secondary causes.

 

[coffeebythelake]

First I mash on their eyeballs and dump ice on their head. When that doesn’t work I go straight to vigorous bilateral carotid massage.

Bilateral carotid massage?? Hahahhaaa ok

 

[Noyac]

I’ve had Adenosine not work tried Esmolo next and no bueno. Did carotid message and BAM. All good.

 

[anbuitachi]

I’ve had Adenosine not work tried Esmolo next and no bueno. Did carotid message and BAM. All good.

Ever tried neostigmine?

 

[coffeebythelake]

Ever tried neostigmine?

why....

 

[T-burglar]

Put one nerve stimulator on each carotid sinus and hit SUSTAINED TETANY WOOOO

 

[WholeLottaGame7]

I've broken it occasionally with a good Valsalva via the vent.

 

[deleted171991]

why....

Vagal maneuver, I guess. 😕

 

[anbuitachi]

Put one nerve stimulator on each carotid sinus and hit SUSTAINED TETANY WOOOO

That's smart. Did this work for you?

 

[jwk]

Ever tried neostigmine?

Old school!

 

[btbam]

Ice to face/valsalva on vent --> adenosine --> cardiovert. Have had it happen in kids a few times.

 

[anbuitachi]

Ice to face/valsalva on vent --> adenosine --> cardiovert. Have had it happen in kids a few times.

ive never actually done the ice one before. tried valsalva / carotid massage. how many Kg of ice do you dump on the patients face?

 

[btbam]

ive never actually done the ice one before. tried valsalva / carotid massage. how many Kg of ice do you dump on the patients face?

They were all toddlers, so just a ziploc bag filled with ice/water mixture and quickly applied to the face.

 

[Noyac]

Ever tried neostigmine?

Can’t say that I have.
You?
How did it do?

 

[deleted171991]

Use of low-dose neostigmine intravenously in the treatment of supraventricular tachycardia: An immediate bradycardic effect - ScienceDirect

 

[anbuitachi]

Use of low-dose neostigmine intravenously in the treatment of supraventricular tachycardia: An immediate bradycardic effect - ScienceDirect

Anyone with access , what is their 'low dose'?

 

[pgg]

Bonus code brown?

 

[Urzuz]

Bonus code brown?

When you don't want the CRNA to feel awkward being the only one after the patient's run of SVT